Driving experience, crashes and traffic citations of teenage beginning drivers

Teenagers were surveyed by telephone every 6 months from their freshman to senior high school years (N=911). Self-reported crash involvements and citations were examined for each teenager's first year of licensure and first 3500 miles driven. Based on survival analysis, the risk of a first crash during the first month of licensure (0.053) was substantially higher than during any of the next 11 months (mean risk per month: 0.025). The likelihood of a first citation during the first month of licensure (0.023) also was higher than during any of the subsequent 11 months (mean risk per month: 0.012). Similarly, when viewed as a function of cumulative miles driven, the risk of a first crash or citation was highest during the first 500 miles driven after licensure. Fewer parental restrictions (e.g. no nighttime curfew) and a lower grade point average (GPA) were associated with a higher crash risk. Male gender, a lower GPA and living in a rural area were associated with a higher citation rate.

Reasons Given by Older People for Limitation or Avoidance of Driving

PURPOSE

To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance.

DESIGN AND METHODS

Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one medical and nonmedical reasons for limiting or avoiding driving were examined by age and gender.

RESULTS

Most older people continue to drive; however, many, especially older women, report one or more reasons to limit or avoid driving. Among medical reasons, problems with eyesight are by far the most often cited; no other health problem was identified as a major reason for limitation. Among nonmedical reasons, being concerned about an accident, being concerned about crime, and having no reason to drive were often cited. Important predictors of reported driving limitations were low income, limited functional status, and self-report of poor vision.

IMPLICATIONS

Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.

State practice environments and the supply of physician assistants, nurse practitioners, and certified nurse-midwives

BACKGROUND

Most proposals to increase access to primary care in the United States emphasize increasing the proportion of generalist physicians. Another approach is to increase the number of physician assistants, nurse practitioners, and certified nurse-midwives.

METHODS

We analyzed variations in the regulation of nurse practitioners, physician assistants, and certified nurse-midwives in all 50 states and the District of Columbia. Using a 100-point scoring system, we assigned numerical values to specific characteristics of the practice environment in each state for each group of practitioners, awarding a maximum of 20 points for legal status, 40 points for reimbursement for services, and 40 points for the authority to write prescriptions. We calculated coefficients for the correlation of summary measures of these values within states with estimates of the supply of practitioners per 100,000 population.

RESULTS

There was wide variation among states in both practice-environment scores and practitioner-to-population ratios for all three groups of practitioners. We found positive correlations within states between the supply of physician assistants, nurse practitioners, and certified nurse-midwives and the practice-environment score for the state (Spearman rank-correlation coefficients, 0.63 [P < 0.001], 0.41 [P = 0.003], and 0.51 [P < 0.001], respectively). Positive associations were also found in the states between the supply of generalist physicians and the supply of physician assistants (r = 0.54, P < 0.001) and nurse practitioners (r = 0.35, P = 0.014). Nevertheless, in the 17 states with the greatest shortages of primary care physicians, favorable practice-environment scores were still associated with higher practitioner-to-population ratios for physician assistants (r = 0.68, P = 0.003), nurse practitioners (r = 0.54, P = 0.026), and certified nurse-midwives (r = 0.42, P = 0.09).

CONCLUSIONS

State regulation of physician assistants, nurse practitioners, and certified nurse-midwives varies widely. Favorable practice environments are strongly associated with a larger supply of these practitioners.

Young driver crash rates by licensing age, driving experience, and license phase

BACKGROUND

Few studies have concurrently assessed the influence of age and experience on young driver crashes, in particular in the post-Graduated Driver Licensing (GDL) era. Further, little attention is given to the transition from intermediate to full licensure. We examined the independent and joint contributions of licensing age, driving experience, and GDL license phase on crash rates among the population of young New Jersey (NJ) drivers.

METHODS

From a unique linked database containing licensing and crash data, we selected all drivers who obtained their NJ intermediate license at 17-20 years old from 2006-2009 (n=410,230). We determined the exact age at which each driver obtained an intermediate and full license and created distinct, fixed cohorts of drivers based on their age at intermediate licensure. For each cohort, we calculated and graphed observed monthly crash rates over the first 24 months of licensure. Further, we examined crash rates by age at licensure, driving experience (i.e., time since licensure), and license phase.

RESULTS

First-month crash rates were higher among the youngest drivers (licensed at 17y0m). Drivers who were licensed later experienced a reduced "steepness" in the slope of their crash rates in the critical initial months of driving, but there did not appear to be any incremental benefit of later licensure once drivers had six months of driving experience. Further, at each age, those with more driving experience had lower crash rates; however, the benefit of increased experience was greatest for the substantial proportion of teens licensed immediately after becoming eligible (at 17y0m). Finally, independent of age and experience, teen drivers' crash risk increased substantially at the point of transition to a full license, while drivers of a similar age who remained in the intermediate phase continued to experience a decline in crash rates.

CONCLUSION

Age and driving experience interact to influence crash rates. Further, independent of these two factors, there is an abrupt increase in crash risk at the point of transition from intermediate to full licensure. Future studies should investigate whether this increase is accounted for by a change in driving exposure, driving behaviors, and/or other factors.

Alcohol prevention targeting licensed premises: a study of effects on violence

OBJECTIVE

This research studied the effects of a community alcohol prevention program on violent crimes. Starting in 1996, a 10-year multicomponent program based on community mobilization, training in responsible beverage service for servers and stricter enforcement of existing alcohol laws has been conducted in Stockholm, Sweden. The project has been led by an action group consisting of members from the hospitality industry and the authorities.

METHOD

We used a time-series quasi-experimental design that included a control area. Data on police-reported violence during the period of January 1994 to September 2000 were analyzed through ARIMA modeling.

RESULTS

During the intervention period, violent crimes decreased significantly by 29% in the intervention area, controlled for the development in the control area.

CONCLUSIONS

The intervention seems to have been successful in reducing violent crimes. This effect is most likely due to a combination of various policy changes initiated by the project. The findings support the notion that community action projects working on a local basis can be effective in decreasing alcohol-related problems at licensed premises.

Driver dependent factors and the risk of causing a collision for two wheeled motor vehicles

OBJECTIVE

To assess the effect of driver dependent factors on the risk of causing a collision for two wheeled motor vehicles (TWMVs).

DESIGN

Case control study.

SETTING

Spain, from 1993 to 2002.

SUBJECTS

All drivers of TWMVs involved in the 181 551 collisions between two vehicles recorded in the Spanish registry which did not involve pedestrians, and in which at least one of the vehicles was a TWMV and only one driver had committed a driving infraction. The infractor and non-infractor drivers constituted the case and control groups, respectively.

MAIN OUTCOME MEASURES

Logistic regression analyses were used to obtain crude and adjusted odds ratio estimates for each of the driver related factors recorded in the registry (age, sex, nationality, psychophysical factors, and speeding infractions, among others).

RESULTS

Inappropriate speed was the variable with the greatest influence on the risk of causing a collision, followed by excessive speed and driving under the influence of alcohol. Younger and older drivers, foreign drivers, and driving without a valid license were also associated with a higher risk of causing a collision. In contrast, helmet use, female sex, and longer time in possession of a driving license were associated with a lower risk.

CONCLUSIONS

Although the main driver dependent factors related to the risk of causing a collision for a TWMV were similar to those documented for four wheeled vehicles, several differences in the pattern of associations support the need to study moped and motorcycle crashes separately from crashes involving other types of vehicles.

Predictors of driving cessation in mild-to-moderate dementia

BACKGROUND

Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementia-related factors associated with driving cessation. The purpose of our study was to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia.

METHODS

A 3-year prospective study, the Canadian Outcomes Study in Dementia (COSID) has enrolled 883 patients with mild-to-moderate dementia at 32 centres across Canada. Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for staging (severity), the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behaviour. Factors associated with the decision to quit driving after the baseline assessment were tested with Cox survival analysis.

RESULTS

Of 719 subjects who were or had been drivers, 203 (28.2%) were still driving at baseline. Over an observation period that averaged 23 months, 97 (48.5%) of 200 patients quit driving. Factors predictive of driving cessation included GDS (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.15-2.45), MMSE score (HR 0.90, 95% CI 0.83-0.97) and NPI findings (HR 1.63 for presence of > or = 3 behaviours, 95% CI 1.01-2.62). Among the NPI behaviours, when they were analyzed separately, agitation led to a decreased likelihood of driving cessation (p = 0.019), whereas apathy (p = 0.031) and hallucinations (p = 0.050) led to an increased likelihood.

INTERPRETATION

Cognitive impairment and behaviours such as agitation, apathy and hallucinations were significant predictors of driving cessation in patients with a mild to moderate degree of dementia. These findings should be considered when one counsels patients and their families.

Age-related differences in fatal intersection crashes in the United States

OBJECTIVE

Given the aging U.S. population and resulting number of older drivers in the coming years, it is important to understand the factors leading to their involvement in vehicle crashes and develop counter-measures to reduce their frequency and severity. This is also useful for helping older adults "age in place" in terms of accessibility, mobility, quality of life and safety. Thus, the objective of this study was to provide up-to-date data on differences in age-related risks and rates for involvement in fatal intersection motor-vehicle crashes in the US.

METHODS

Pooled data for the years 2011-2014 from the FARS, a census of fatal traffic crashes within the 50 States, the District of Columbia, and Puerto Rico, created by the US National Highway Traffic Safety Administration (NHTSA) were used to calculate summary statistics including annualized crash rates. Multivariate logistic regression models were used to evaluate age and gender-related differences in fatal intersection crash risk, controlling for covariates. An induced exposure analysis was conducted to calculate crash involvement ratios (CIRs) for all two-vehicle fatal intersection crashes. Older and younger drivers were compared with respect to the presence of factors related to intersection crashes using a multivariate Poisson regression model.

RESULTS

During the period of 2011-2014, among the reported 120,809 fatal accidents in the US involving 178,489 drivers of vehicles, 48,733 (28%) were drivers involved in fatal intersection crashes. Age-adjusted annualized fatal intersection crash rates per 100,000 licensed drivers were highest for drivers aged 85 or older (9.89/100,000), followed by 20 years of age (8.93/100,000). Teen and older drivers (55+ years of age) were over-involved in fatal intersection crashes, drivers from 20 to 54 years old were under-involved. Male and female drivers, 70-74 years of age, were 20% and 21%, respectively, more likely to be involved in a fatal intersection crash than 20-24year olds (of same gender). By age 85, fatal intersection crash risk for all drivers was almost doubled. Significant differences in factors related to crashes involving younger (<65) and older (65+ years) drivers were time of day, lighting and weather conditions, day of week, roadway type and number of lanes, presence of visible traffic controls, speed limit and estimated driving speed, and whether the driver was deemed at fault for the crash CONCLUSION: The results provide the most up-to-date analysis of aging and fatal intersection crash risk in the US, and underscore several trends worthy of further investigation. Older adults face a number of challenges associated with natural aging, including sensory, perceptual, cognitive and motor declines that may impact their driving. As with younger drivers, expanded or renewed approaches to driver training at licensing renewals, as well as safety-based technological advances are viable avenues toward improving the safety outlook for older adults.

Examining the effects of differential item (functioning and differential) test functioning on selection decisions: when are statistically significant effects practically important?

Item response theory differential test functioning (DTP) methods are often used to address issues in personnel selection, but the results are frequently difficult to interpret because statistically significant findings may have little practical importance. In this article, the authors proposed 2 effect size measures for DTP. One related DTP to mean raw score differences across groups: the other related DTP to the 4/5th rule for adverse impact at successive cut scores. The effects of DTP were examined in the context of personality assessment, professional licensure, and college admissions. Overall, the result indicated that although many items exhibited bias in analyses of the large samples, the net magnitudes of effect on potential selection decisions were nugatory.

Validating interpretive arguments for licensure and certification examinations

To validate the interpretation assigned to test scores is to support the rationale for this interpretation. The interpretations for licensure and certification tests involve a sequence of inferences, or an argument, leading from the test score to decisions about licensure or certification. This article examines several possible interpretive arguments for licensure and certification test scores and analyzes the evidence required to support each type of argument. Particular attention is given to a competency-based argument that involves a sequence of several inferences leading from test scores to statements about competence, and then to conclusions about expected performance in practice. Decisions about licensure or certification are based on expected performance in practice.

CASPer, an online pre-interview screen for personal/professional characteristics: prediction of national licensure scores

Typically, only a minority of applicants to health professional training are invited to interview. However, pre-interview measures of cognitive skills predict for national licensure scores (Gauer et al. in Med Educ Online 21 2016) and subsequently licensure scores predict for performance in practice (Tamblyn et al. in JAMA 288(23): 3019-3026, 2002; Tamblyn et al. in JAMA 298(9):993-1001, 2007). Assessment of personal and professional characteristics, with the same psychometric rigour of measures of cognitive abilities, are needed upstream in the selection to health profession training programs. To fill that need, Computer-based Assessment for Sampling Personal characteristics (CASPer)-an on-line, video-based screening test-was created. In this paper, we examine the correlation between CASPer and Canadian national licensure examination outcomes in 109 doctors who took CASPer at the time of selection to medical school. Specifically, CASPer scores were correlated against performance on cognitive and 'non-cognitive' subsections of both the Medical Council of Canada Qualifying Examination (MCCQE) Parts I (end of medical school) and Part II (18 months into specialty training). Unlike most national licensure exams, MCCQE has specific subcomponents examining personal/professional qualities, providing a unique opportunity for comparison. The results demonstrated moderate predictive validity of CASPer to national licensure outcomes of personal/professional characteristics three to six years after admission to medical school. These types of disattenuated correlations (r = 0.3-0.5) are not otherwise predicted by traditional screening measures. These data support the ability of a computer-based strategy to screen applicants in a feasible, reliable test, which has now demonstrated predictive validity, lending evidence of its validation for medical school applicant selection.

A comparison of registered and unregistered female sex workers in Tijuana, Mexico

OBJECTIVE

Sex work is regulated in Tijuana, Mexico, but only half of the city's female sex workers (FSWs) are registered with the municipal health department, which requires regular screening for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). We examined correlates of registration to determine if it confers measurable health benefits.

METHODS

From 2004 to 2006, we interviewed FSWs in Tijuana > or = 18 years of age who reported recent unprotected sex with at least one client and were not knowingly HIV-positive, and tested them for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with registration.

RESULTS

Of 410 FSWs, 44% were registered, 69% had been tested for HIV, 6% were HIV-positive, and 44% tested positive for any STI. Compared with unregistered FSWs, registered FSWs were more likely to have had HIV testing (86% vs. 56%, p < 0.001) and less likely to test positive for any STI (33% vs. 53%, p < 0.001) or HIV (3% vs. 8%, p = 0.039). Factors independently associated with registration included ever having an HIV test (adjusted odds ratio [AOR] = 4.19) and earning > $30 per transaction without a condom (AOR = 2.41), whereas working on the street (AOR = 0.34), injecting cocaine (AOR = 0.06), snorting or smoking methamphetamine (AOR = 0.27), and being born in the Mexican state of Baja California (AOR = 0.35) were inversely associated with registration.

CONCLUSION

Registered FSWs were more likely than unregistered FSWs to have had HIV testing and to engage in less drug use, but did not have significantly lower HIV or STI prevalence after adjusting for confounders. Current regulation of FSWs in Tijuana should be further examined to enhance the potential public health benefits of registration.

New active substances authorized in the United Kingdom between 1972 and 1994

AIMS

The study was undertaken to assemble a list of all new active medicinal substances authorised in the United Kingdom between 1972 and 1994; to assess whether the pattern of introductions had changed; and to examine withdrawal rates and the reasons for withdrawal.

METHODS

The identities of those new active substances whose manufacturers had obtained Product Licences between 1972 and 1994 were sought from the Medicines Control Agency's product data-base. For each substance relevant information was retrieved including the year of granting the Product Licence, its therapeutic class, whether currently authorised (and, if not, reason for withdrawal), and its nature (chemical, biological etc.).

RESULTS

The Medicines Control Agency's data-base was cross-checked against two other data-bases for completeness. A total of 583 new active substances (in 579 products) were found to have been authorised over the study period. The annual rates of authorisation varied widely (9 to 40 per year). Whilst there was no evidence for any overall change in the annual rates of authorising new chemical entities, there has been a trend for increasing numbers of new products of biological origin to be authorised in recent years. Fifty-nine of the 583 new active substances have been withdrawn (1 each for quality and efficacy, 22 for safety, and 35 for commercial reasons).

CONCLUSIONS

For reasons that are unclear there is marked heterogeneity in the annual rates of authorisation of new active substances. Their 10 year survival is approximately 88% with withdrawals being, predominantly, for commercial or safety reasons. This confirms the provisional nature of assessments about safety at the time when a new active substance is introduced into routine clinical practice, and emphasises the importance of pharmacovigilance.

Quality of pharmacies in Pakistan: a cross-sectional survey

OBJECTIVE

To estimate the proportion of pharmacies meeting licensing requirements and to identify factors associated with these pharmacies in urban Rawalpindi, Pakistan.

DESIGN

Cross-sectional questionnaire survey conducted during July-September 2001, of 311 pharmacies selected from a drug company list of 506.

SETTING

Free-standing licensed and unlicensed pharmacies in urban Rawalpindi.

STUDY PARTICIPANTS

A pharmacist or (if unavailable) the most experienced drug seller.

RESULTS

The proportion of pharmacies meeting licensing requirements was 19.3% [95% C.I (confidence interval): 15.1, 24.2], with few qualified persons (22%). Only 10% had a temperature-monitoring device and 4% an alternative power supply for refrigerators (present in 76% of pharmacies). Associated with pharmacies meeting licensing requirements was the knowledge of not giving co-trimoxazole, a prescription drug, without prescription [OR (odds ratio) = 2.0; 95% CI: 1.1, 3.6], knowledge of the temperature range for vaccines (OR = 2.6; 95% CI: 1.4, 4.8), availability of vaccines (OR = 2.8; 95% CI: 2.8, 18.4), and alternative power supply for the refrigerator (OR = 6.0; 95% CI: 1.5, 23.7). The practice of selling drugs without prescription was not found to have a significant association (OR = 1.1; 95% CI: 0.5, 2.3); however, it did show a trend indicating discrepancy between knowledge and practice.

CONCLUSIONS

Most drug sellers had fragmentary knowledge regarding drug dispensing and storage, and improper dispensing practices. There is a need to enforce existing legislation with training programmes directed towards drug sellers and to involve the pharmaceutical industry, which plays an important role in influencing pharmacy knowledge and practices.

Validation of professional licensure examinations. Professions theory, test design, and construct validity

Although the unitary view of test validity has gained support recently, it has real limitations where professional licensing examinations are concerned. A strategy for validation of professional licensure tests requires modifying conventional approaches in three ways. First, a theory of professions must be incorporated into the test development process so as to acknowledge the social character of professions. Second, the importance of test design in the validation of licensing tests should be enhanced. Third, the concept of construct validation must be expanded to accommodate the special features of content that inhere to professional licensure testing. Methods for accomplishing these three things are described and the implications of these and other views discussed.

Young driver risky behaviour and predictors of crash risk in Australia, New Zealand and Colombia: Same but different?

Young drivers remain overrepresented in road crashes around the world, with road injury the leading cause of death among adolescents. In addition, the majority of road traffic crashes, fatalities and injuries occur in low- and middle-income countries. All young drivers are at risk due to a breadth of age- and inexperience-related factors; however it is well recognised that young drivers may also intentionally engage in risky driving behaviours which increase their crash risk. The aim of this paper is to examine the self-reported risky driving behaviour of young drivers in Australia, New Zealand (high-income countries), and Colombia (middle-income country), and to explore the utility of a crash risk assessment model in these three countries. Young drivers aged 16-25 years completed the Behaviour of Young Novice Drivers Scale (BYNDS), in addition to self-reporting crash involvement and driving offences. A hierarchical segmentation analysis via decision trees was used to study the relationship between self-reported crashes and risky driving. Young drivers in Colombia reported more risky driving than young drivers in New Zealand, and considerably more risky driving than young drivers in Australia. Significant differences among and across countries in individual BYNDS items were found, and 23.5% of all participants reported they had been involved in a road crash. Handheld mobile phone usage was the strongest predictor of crashes, followed by driving after drinking alcohol, and carrying friends as passengers. Country of origin predicted mobile phone usage, with New Zealand and Colombia grouped in the same decision tree branch which implies no significant differences in the behaviour between these countries. Despite cultural differences in licensing programs and enforcement, young drivers reported engaging in a similar breadth of risky behaviours. Road crashes were explained by mobile phone usage, drink driving and driving with passengers, suggesting interventions should target these three risk factors. Whilst New Zealand and Australia have implemented graduated driver licensing programs, are geographical neighbours, and are high-income countries, the finding that behaviours of young drivers in New Zealand and Colombia were more similar than those of young drivers in New Zealand and Australia merits further investigation.

Opportunities for video lottery terminal gambling in Montréal: an environmental analysis

BACKGROUND

In the province of Québec, video lottery terminal (VLT) gambling has proliferated under government control since 1993. The aims of this study were to describe the spatial distribution of video lottery terminals (VLTs) in the municipalities of Montréal and Laval and to identify neighbourhood socio-economic conditions associated with their distribution.

METHOD

Locations of all establishments holding VLT licences in Montréal and Laval (n = 834) were geocoded by their street address. Boroughs (n = 49) were characterized by socio-economic indicators (unemployment, educational attainment, lone parenthood), a neighbourhood distress index, and measures of VLT prevalence, VLT adoption and VLT density.

RESULTS

VLT prevalence, adoption and density were strongly correlated (p < 0.01) with lower borough socio-economic conditions. Although liquor establishments were also more likely to be located in poorer neighbourhoods, the adoption rate of VLT licences by bars in poorer neighbourhoods was systematically higher than in more affluent ones.

CONCLUSIONS

The spatial distribution of VLTs in Montréal and Laval closely reflects local geographies of socio-economic disadvantage. Any public health effort to reduce the burden of gambling-related health and social problems must recognize the spatial distortion of gambling opportunities in the urban environment.

Restriction of the hours of sale of alcohol in a small community: a beneficial impact

The population of Halls Creek, a small town in the remote Kimberley region of Western Australia, is predominantly Aboriginal. After many years of high alcohol consumption, a number of measures were taken in an effort to redress its negative influence on the community. Key among these was a restriction on the trading hours when 'take-away' alcohol was available. The effects of this intervention were monitored by examining longitudinal patterns of alcohol consumption, incidence of crime and outpatient data at the local hospital. The data were compared with equivalent periods prior to the restricted trading hours. A decrease in alcohol consumption was observed for each of the two years following the intervention. Overall, incidence of crime declined. Alcohol-related presentations to the hospital and presentations resulting from domestic violence decreased relative to the equivalent quarterly period prior to the intervention. There were short-term fluctuations observed, particularly with domestic violence, where presentations (of lesser severity) became more frequent during several quarters. Emergency evacuations as a result of injury showed a marked decrease. The consistency of trends across a variety of health and social data show a positive effect after the implementation of restricted trading hours. While a direct effect is likely, a multitude of concurrent programs which promote health in the community place limitations on this conclusion. The process in achieving change, supported by statutory measures, has, however, been successful in curbing the morbidity and mortality experienced by the community.

Tackling alcohol related violence in city centres: effect of emergency medicine and police intervention

OBJECTIVES

To identify correlates of alcohol related assault injury in the city centre of a European capital city, with particular reference to emergency department (ED) and police interventions, and number and capacity of licensed premises.

METHODS

Assaults resulting in ED treatment were studied using a longitudinal controlled intervention, a three stage design during a three year period of rapid expansion in the night-time economy, when ED initiated targeted police interventions were delivered. A controlled ED intervention targeted at high risk night-clubs was carried out. Main outcome measure was ED treatment after assault in licensed premises and the street.

RESULTS

Targeted police intervention was associated with substantial reductions in assaults in licensed premises but unexpected increases in street assault were also observed (34% overall: 105% in the principal entertainment thoroughfare). Combined police/ED intervention was associated with a significantly greater reduction compared with police intervention alone (OR = 0.61, 95% CI 0.40 to 0.91). Street assault correlated significantly with numbers and capacity of premises. Risk of assault was 50% greater in and around licensed premises in the city centre compared with those in the suburbs, although dispersion of violence to more licensed premises was not observed.

CONCLUSIONS

Marked decreases in licensed premises assaults resulting from targeted policing were enhanced by the intervention of ED and maxillofacial consultants. Capacity of licensed premises was a major predictor of assaults in the city centre street in which they are clustered. City centre assault injury prevention can be achieved through police/ED interventions targeted at high risk licensed premises, which should also target the streets around which these premises are clustered.

Risk factors in motorcyclist fatalities in Taiwan

OBJECTIVE

To assess the impact of the following factors on rider fatality: rider's age, gender, licensing status, accident liability, use of helmet, alcohol consumption, vehicle class, road conditions, presence of passengers, and passenger injuries.

METHODS

Data on motorcycle accidents in Taiwan between 2006 and 2008 were analyzed. A logistic regression model was used to establish a fatality risk model for motorcyclists and investigate high-risk factors for motorcyclist fatality.

RESULTS

Higher fatality rates among motorcycle riders correlate with the following factors: male, older, unlicensed, not wearing a helmet, riding after drinking, and driving heavy (i.e., above 550 cc) motorcycles. In addition, motorcyclists involved in nighttime, nonurban single-vehicle accidents have a higher risk of death, and lone riders have a higher risk of death in accidents than do riders carrying passengers. The seriousness of passenger injury also correlates positively with the rider's risk of death.

CONCLUSIONS

Nearly 60 percent of all driving fatalities in Taiwan involve motorcycles. Consideration of factors behind the high frequency and risk of motorcycle deaths, specifically rider age above 60 years, not wearing a motorcycle helmet, riding after drinking, and driving without a valid license, could help in the development of effective traffic safety management measures.

The New Zealand graduated driver licensing system: teenagers' attitudes towards and experiences with this car driver licensing system

OBJECTIVES

This study examined the attitudes of teenagers towards the New Zealand graduated driver licensing system (GDLS), and the extent to which it affected them.

METHOD

Teenagers, who are members of a longitudinal study of a birth cohort, were interviewed at 15 years of age when the GDLS was first introduced and before they had begun licensure, and again at 18 years of age after they had experience with this licensing system.

RESULTS

At both ages the majority (over 70%) agreed with the driving restrictions imposed by this system. After experience with the restrictions, however, significantly more reported being affected a lot by them, than had expected to be at age 15. This was especially true of the restrictions on the carrying of passengers and the night time curfew (10 pm - 5 am). However, few reported that they were affected by the alcohol restriction. Sixty eight per cent of those with a graduated licence reported breaking at least one of the conditions, most frequently carrying passengers. Very few were penalised by the police for this.

CONCLUSIONS

Generally these young drivers were positively disposed towards the driving restrictions, but noncompliance was common. A full evaluation of all aspects of this licensing system is recommended.

Single-vehicle crashes and alcohol: a retrospective study of passenger car fatalities in northern Sweden

This retrospective study of fatal passenger car crash victims in northern Sweden compares 396 multiple-vehicle (MV) and 201 single-vehicle (SV) fatalities from 1980 through 1989. Compared to MV fatalities, SV victims were more frequently males, were younger, were more often inebriated, had higher blood alcohol concentrations, had a higher frequency of fatty liver, and were less often restrained. The SV fatalities occurred most often from May through October, from Fridays through Sundays, and from 9 p.m. to 6 a.m. The road surface was usually dry, especially for drunken SV drivers. The SV drivers also more often lacked a valid driver's license. The study confirms that alcohol is one of the most important factors associated with traffic fatalities, particularly in SV crashes. More than half (56%) of the SV victims were inebriated by alcohol (MV, 11%), had a mean blood alcohol concentration of 1.9 g/l (MV, 1.6 g/l), and one-third had a fatty liver (MV, 20%). We also found a relation between fatty liver and increased blood alcohol concentrations, suggesting that studies regarding the role of alcohol in traffic fatalities should also include an evaluation of liver morphology.

Iowa nursing home characteristics associated with reported abuse

OBJECTIVE

To evaluate the association of nursing home abuse reported by employees in Iowa licensed nursing homes with nursing home characteristics, inspection results, nursing staff hours, and census demographics.

DESIGN

Mailed survey.

SETTING

Iowa's 409 Medicare-certified stand-alone nursing homes.

PARTICIPANTS

Administrators and directors of nursing.

RESULTS

The annual rate of abusive events was 20.7 per 1000 nursing home residents, with a rate of 18.4 reported events and 5.2 substantiated events. A higher number of residents and a higher number of certified beds were significantly associated with higher incident, report, and substantiation rates. Higher incident and report rates were associated with nursing homes in metropolitan areas. Higher substantiation rates were associated with for-profit nursing homes.

CONCLUSION

Recognized abuse in nursing homes is not uncommon. Approximately 90% of events are reported to the state authorities with 29% of those being substantiated. Differences associated with nursing facility abuse rates are metropolitan area, ownership, occupancy rate, and number of residents and certified beds.